Annals of Family Medicine最新文献

{"title":"Impact of State Abortion Policies on Family Medicine Practice and Training After <i>Dobbs v Jackson Women's Health Organization</i>.","authors":"Karen L Roper, Sarah Jane Robbins, Philip Day, Grace Shih, Neelima Kale","doi":"10.1370/afm.3183","DOIUrl":"10.1370/afm.3183","url":null,"abstract":"<p><strong>Purpose: </strong>The <i>Dobbs v Jackson Women's Health Organization</i> (Dobbs) Supreme Court decision revoked the constitutional right to abortion. Now, restrictive state abortion laws may contribute to the shortage and strain already felt in primary care practice, especially related to the provision of reproductive health care. The purpose of this study is to evaluate perceived impacts of state abortion legislation on family medicine clinicians' practice and medical education regarding reproductive health care.</p><p><strong>Methods: </strong>Ten questions were added to the 2022 Council of Academic Family Medicine Educational Research Alliance general membership survey to evaluate impact on relevant themes in reproductive health care and training after the Dobbs decision. Responses were categorized by severity of restriction of state abortion policies.</p><p><strong>Results: </strong>Of 1,196 respondents, 49.7% reported employment in states with very restrictive or restrictive abortion policies. The 991 respondents with clinical responsibilities reported significant (<i>P</i> <.05) changes in their counseling practices, clinical decision making, worry of legal risks, and trust in patients' self-reported reproductive medical history, compared with peers in protective states. Perceived patient trust toward clinicians remained unchanged. Almost one-half of clinical respondents reported an absence of reproductive health care guidance or recommendations. Restrictive abortion policies significantly (<i>P</i> <.05) reduced the desirability and confidence in resident training programs.</p><p><strong>Conclusions: </strong>Reported changes to clinical activities and training, coming early after the Dobbs decision, affect our current and future workforce and therefore, our patients. Future studies are needed to document continued impact of state restrictions and inform policy to support family medicine clinicians in reproductive health practice and education.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 6","pages":"492-501"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning From Ervin's Care: Ethics, Health Care Finance, and Human Connection.","authors":"Amy C Denham","doi":"10.1370/afm.3182","DOIUrl":"10.1370/afm.3182","url":null,"abstract":"<p><p>A 70-year-old man with complex multimorbidity and intellectual disability was my patient for the last 5 years of his life. He taught me important lessons about the challenges of practicing medicine as a primary care physician. He embodied all the complexities of multimorbidity, the ways in which clinical decision making can be fraught with uncertainties and tradeoffs. He raised difficult ethical questions for his care team, questions about how to respect the dignity of patients who lack decisional capacity and who do not have surrogate decision makers. The gaps in his care revealed shortcomings of the US health care system, but his care in his final years also showed some of the bright spots in coordinated, team-based care. Most importantly, caring for this patient taught me about the rewards of the human connections that primary care physicians establish with their patients.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 6","pages":"565-567"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Collaborative, Trauma-Informed Care on Depression Outcomes in Primary Care: A Cluster Randomized Control Trial in Chile.","authors":"Verónica G Vitriol, Alfredo Cancino, María de la Luz Aylwin, Soledad Ballesteros, Andrés F Sciolla","doi":"10.1370/afm.3184","DOIUrl":"10.1370/afm.3184","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to evaluate the effectiveness of collaborative trauma-informed care (CTIC) for treating depression in primary care in Chile.</p><p><strong>Methods: </strong>From August 2021 through June 2023, 16 primary care teams in the Maule Region of Chile, were randomly assigned to either the CTIC or usual treatment (UT) group. At baseline, 3 months, and 6 months, 115 patients in the CTIC group, and 99 in the UT group, were blindly evaluated. The primary outcome was reduction in depressive symptoms. Secondary outcomes included improvement in anxiety symptoms, interpersonal and social functioning, emotional regulation, and adherence. Intention-to-treat data analysis, using analysis of covariance was conducted.</p><p><strong>Results: </strong>There were 214 patients recruited; 85% were women, and 61% had 4 or more adverse childhood experiences. At 6 months, depressive symptoms declined significantly in the CTIC arm relative to UT (adjusted mean difference [AMD]= -3.09, 95% CI, -4.94 to -1.23; d = -0.46, 95% CI,-0.73 to -0.18; <i>P</i> = .001). Anxiety symptoms exhibited a trend toward improvement in the CTIC vs UT group (AMD = -1.50, 95% CI, -3.03 to 0.31; <i>P</i> = .055). No significant differences were observed in other secondary outcomes, except for adherence, which was significantly higher in the CTIC vs UT groups (AMD = 2.59, 95% CI, 1.80-4.99; <i>P</i> = .035).</p><p><strong>Conclusions: </strong>The CTIC approach demonstrated superior outcomes in treating depression and improving adherence compared with UT. Moreover, the observed trends in anxiety improvement warrant further exploration in future research with a larger sample size. It is necessary to assess the effectiveness of this approach in treating more complex, difficult-to-treat forms of depression.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 6","pages":"467-475"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PBRNs are Back, Baby!","authors":"Joseph LeMaster, Christina M Hester, Wilson Pace, Jack Westfall, Kurt Stange","doi":"10.1370/afm.240498","DOIUrl":"10.1370/afm.240498","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 6","pages":"573-574"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Early Detection of Cognitive Impairment in Older Adults in Primary Care Clinics: Recommendations From an Interdisciplinary Geriatrics Summit.","authors":"Robin C Hilsabeck, William Perry, Laura Lacritz, Peter A Arnett, Raj C Shah, Soo Borson, James E Galvin, Kimberly Roaten, Morgan Daven, Ula Hwang, Laurie Ivey, Pallavi Joshi, Abby Luck Parish, Julie Wood, Jonathan Woodhouse, Jean Tsai, Michelle Sorweid, Usha Subramanian","doi":"10.1370/afm.3174","DOIUrl":"10.1370/afm.3174","url":null,"abstract":"<p><p>As the population ages, the prevalence of cognitive impairment due to neurodegenerative diseases such as Alzheimer disease (AD) is expected to double in the United States to nearly 14 million over the next 40 years. AD and related dementias (ADRD) are a leading cause of morbidity and mortality and among the costliest to society. Although emerging biomedical interventions for ADRD focus on early stages and are currently limited to AD, care management can benefit patients with ADRD across the disease course. Moreover, some causes of cognitive impairment are modifiable, and optimal overall management may slow or prevent additional decline. Nevertheless, a sizable proportion of cases of cognitive impairment among older adults remain undiagnosed. Primary care practitioners are often the first health care professionals to encounter cognitive concerns or to be able to observe changes in function resulting from cognitive impairment; hence, they have much to contribute to population health solutions for detecting cognitive impairment among older adults. In this report, we present key points and gaps in knowledge about methods for detecting cognitive impairment in primary care clinics. These were developed via an interdisciplinary Geriatrics Summit hosted by the National Academy of Neuropsychology in 2022, attended by representatives of national organizations engaged in work to improve care of older adults. We propose a novel workflow to facilitate detecting cognitive impairment during routine primary care, focusing on opportunities provided by the annual wellness visit, a preventive visit available to Medicare beneficiaries, along with additional recommendations and opportunities for clinical practice and research.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 6","pages":"543-549"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons on Leadership from Leads: Leadership Education for Academic Development and Success.","authors":"José E Rodríguez, Jenifer Wilson, José E Rodríguez, Casey Crump, Phillip T Dooley, Parastou Farhadian, Luz Fernandez, Jamie Hill-Daniel, Shashank Kraleti, Sarah Kureshi, Jennifer Molokwu, John Snellings, Justin M Wright, Alexandra Verdieck-Devlaeminck, Myra Muramoto, Valerie Gilchrist","doi":"10.1370/afm.240497","DOIUrl":"10.1370/afm.240497","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 6","pages":"571-572"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treating Depression With Trauma-Informed Care in Chile.","authors":"Michael E Johansen","doi":"10.1370/afm.240562","DOIUrl":"10.1370/afm.240562","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 6","pages":"576"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unhurried Conversations in Health Care Are More Important Than Ever: Identifying Key Communication Practices for Careful and Kind Care.","authors":"Dawna I Ballard, Dron M Mandhana, Yohanna Tesfai, Cristian Soto Jacome, Sarah B Johnson, Michael R Gionfriddo, Nataly R Espinoza Suarez, Sandra Algarin Perneth, Lillian Su, Victor M Montori","doi":"10.1370/afm.3177","DOIUrl":"10.1370/afm.3177","url":null,"abstract":"<p><p>Unhurried conversations are necessary for careful and kind care that is responsive and responsible to both patients and clinicians. Adequate conceptual development is an important first step in being able to assess and measure this important domain of quality of care. In this article, we expand on a preliminary model to identify the key microlevel communication practices that support an unhurried conversation, defined as an ongoing, mutual accomplishment between patient and clinician that proceeds through a range of verbal and nonverbal communication practices wherein one or more participants (mutually) regulate the sequence, spacing (temporal and spatial), and speed of interaction to make themselves available to the other and remove or suspend distractions from the environment in order to improve care. We draw from the rich, qualitative descriptions found in earlier work that point to specific, observable practices in clinical encounters and identified empirical and theoretical work across a range of disciplines to expand our understanding of these practices. Ultimately, we identify and elaborate on 10 observable indicators of patient-clinician communication: engaging in shared turn taking, establishing rapport through discussion of off-task topics, pausing to allow the other ample time to speak, moderating the pace of spoken language, avoiding conversational interruptions, minimizing external interruptions, triaging topics as needed to create adequate time, expressing emotions, encouraging participation through inviting questions, and displaying open body language. These indicators work together to cocreate unhurried conversations.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 6","pages":"533-538"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the Gap: Transforming Primary Care Through the Artificial Intelligence and Machine Learning for Primary Care (AIM-PC) Curriculum.","authors":"Winston Liaw, Brian Hischier, Cornelius A James, Ioannis Kakadiaris, Jacqueline K Kueper, Vasiliki Rahimzadeh","doi":"10.1370/afm.240537","DOIUrl":"10.1370/afm.240537","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 6","pages":"570-571"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in Receiving Care for Long COVID: A Qualitative Interview Study Among Primary Care Patients About Expectations and Experiences.","authors":"Elena Gardner, Alex Lockrey, Kirsten L Stoesser, Jennifer P Leiser, Jeanette Brown, Bernadette Kiraly, Dominik J Ose","doi":"10.1370/afm.3145","DOIUrl":"10.1370/afm.3145","url":null,"abstract":"<p><strong>Background: </strong>For many patients with post-COVID-19 condition (long COVID), primary care is the first point of interaction with the health care system. In principle, primary care is well situated to manage long COVID. Beyond expressions of disempowerment, however, the patient's perspective regarding the quality of long COVID care is lacking. Therefore, this study aimed to analyze the expectations and experiences of primary care patients seeking treatment for long COVID.</p><p><strong>Methods: </strong>A phenomenological approach guided this analysis. Using purposive sampling, we conducted semistructured interviews with English-speaking, adult primary care patients describing symptoms of long COVID. We deidentified and transcribed the recorded interviews. Transcripts were analyzed using inductive qualitative content analysis.</p><p><strong>Results: </strong>This article reports results from 19 interviews (53% female, mean age = 54 years). Patients expected their primary care practitioners (PCPs) to be knowledgeable about long COVID, attentive to their individual condition, and to engage in collaborative processes for treatment. Patients described 2 areas of experiences. First, interactions with clinicians were perceived as positive when clinicians were honest and validating, and negative when patients felt dismissed or discouraged. Second, patients described challenges navigating the fragmented US health care system when coordinating care, treatment and testing, and payment.</p><p><strong>Conclusion: </strong>Primary care patients' experiences seeking care for long COVID are incongruent with their expectations. Patients must overcome barriers at each level of the health care system and are frustrated by the constant challenges. PCPs and other health care professionals might increase congruence with expectations and experiences through listening, validating, and advocating for patients with long COVID.<i>Annals</i> Early Access article.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":" ","pages":"369-374"},"PeriodicalIF":4.4,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}